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FOR OFF CE US�: Permifi No. ... ..�( - APPLICATION FOR SANITATION PERMIT ---- (Complete in Duplicate) Date Is _--- ---__----- ----_-.____.--. This Permit Expires 1 Year From Date Issued sued .._.__/_!�. ...L� - ------------_- - - Application is hereby made to the San Joaquin Local Health District for a permit to construct and in II the work herein described. This application is made in compliance with County Ordinance No. 549. zLz Ori JOB ADDRESS AND LOCATION.------ !�- •-•--�� -----� ...... Owner's Name--------------- .... r -------- ------ Phone..� �- Address-------------- ---------............. ----•- _ ____- ----------- ------------------------_-_-------_--------------••---------------------------•---•- i Phone.. --•-- Contractor's Name---------------------------------------------- Installation will serve: Residence 0 Apartment House ❑ Commercial ElTrailer Court F1Motel ❑ Other [I Number of living units: _.1____ Number of bedrooms __Number of baths __,l_. Lot size ____--____ -..... Water Supply: Public system ❑ Community system ❑ Private ®' Depth To Water Table /_A�_ft- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 3 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date___________________) No [ZC New Construction: Yes ❑ No [a FHA/VA: Yes ❑ No � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_____4'9--Distance from foundation--------lam.__.Material-_.____ — - -'�" -• L____ Capacity " Q. .No. of compartment��-- ----------_-Size---•--�_4 -----------�_A i uid depth Disposal Field: Distance from nearest well...._�s»_�'.-Distance from foundation..-----2-_-'___.Distance to nearest lot line..___. -.. Number of lines--------_____/____ -----'-----Length sof each line-.----- _ __ ____-Width of french--------.,-___--___-___......- Type of filter mate_Gal'._� epth of filter material_..--/ --------Total length__...--___.... -• ---------- Distance foundation to nearest lot line__----------- Seepage Pit: Distance to nearest well_____ ❑ Number of pits------!�---------_-Lining material---I------------------.Size: Diameter--------------.___---- Depth------- ______.._______-__-- :� {" •, .i Cesspool: Distance from .nearest well°_____________ __Distance from foundation...__-_-____.-..-__.Lining material __.______--__-____.-__________---_-_ ❑ Size: Diameter y_--- --------------------------------Depth---•k------------------•----------------------------Liquid Capacity------------_-------_---gals. r Privy: Distance from nearest well---------------_____---------I-------_-_------Distance from nearest building_________.____.-___._____._-.------.----. ❑ Distance to nearest lot line______________________ _ ° r Remodeling and/or repairing (describe)-------------------------------------------} 1 ---- ---- -------•---------------------------------------------•-------- ------------------------------------------------------•-•------------------•-----------------------------------•----------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (signed)--M ..__�=--�----- ---- � _ -------_-----------------------------------------------------•----------------{Owner and/or Contractor) BY:- -----------------------------------------------------------------•----(rale)---------- ----------------------------------------------------- (Plot plan, showing size of lot, location'of system in relation to wells, buildings, etc., can be placed on reverse side). t DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- --- 5---7 - DATE-----------• -------------- REVIEWEDBY------------------------------------------ -------- ------- ---------- --------•--- ----------------------- DATE BUILDINGPERMIT ISSUED--------------------------------- ----------------•-----------------------....-------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:------------ -------------------- --------- -------_-----..--------- -•---------------•-----....----------------...-----•---...--------•-------------------- -----------------------------------------------------•---•---•----•---•----------•--------•------------------------------•------------ ---------------------------------- ---•--------•-------------------------•-------------•------------;---------------------------------------- --- --------------:--------- -------- -•.................•-------------------•-••------------- ---------•------- -•---------------------- ---- --------------- -•---------- ---- ------ FINAL INSPECTION BY:..-- -- -`- ----- Date--- -- z ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 134 Sycamore Street 205 West 41h Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 2M 5-62 ATLAS